Under CMS's Patient-Driven Groupings Model (PDGM), home health agencies require relentless precision in OASIS documentation, primary diagnosis grouping, and LUPA risk prevention.
Improper diagnosis sequencing or inconsistencies between the clinical narrative and OASIS functional assessment items can trigger low-utilization payment thresholds (LUPA) or immediate claim returns.
V1RCM's certified home health coders (HCS-D, COS-C) perform dual-level audits of OASIS assessments, ensure appropriate primary diagnosis grouping under PDGM, and assign valid HIPPS codes within 24 to 48 hours.